<![CDATA[Although the cognitive challenges of paraphrasing are well-documented, the metacognitive experiences and psychological distress of EFL learners navigating highly technical texts remain critically underexplored. To address this gap, this qualitative study explores the specific metacognitive challenges, uncertainty, and coping strategies of Indonesian health science writers when reformulating specialized disciplinary literature. Situated within an interpretive qualitative design, the data were collected from 64 undergraduate pharmacy students engaged in two paraphrasing tasks. Participants were given the autonomy to use or abstain from artificial intelligence (AI) assistance, and they were assigned to write concurrent metacognitive reflections on the emotions they experienced. Utilizing an interactive model of qualitative data analysis, the findings indicated that participants experienced epistemic uncertainty and cognitive anxiety driven by the conflicting demands of deep syntactic restructuring and maintaining rigorous scientific accuracy. Specifically, learners reported profound challenges with self-efficacy, particularly when selecting technical lexical synonyms and interpreting the source material. To manage this cognitive load and the persistent fear of unintentional plagiarism, a notable portion of learners exhibited avoidance behaviors, manifesting as a strategic dependence on AI and digital writing tools. These findings suggested that EFL paraphrasing instruction must transcend mechanical restructuring to explicitly address metacognitive regulation and AI-assisted writing behaviors, indicating that future pedagogical interventions should integrate emotional scaffolding to foster writing self-efficacy and academic integrity.]]>
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